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t m c » p u l s e | m a r c h 2 0 1 5 14 Danger at the Heart of Pregnancy Doctors in the Texas Medical Center are working hard to identify and treat women suffering from a rare life-threatening heart condition that strikes during pregnancy B y H e a t h e r H e m i n g w a y early—only two days after her own hos- pitalization—on June 10, 1998, weighing 9 pounds 2 ounces. Now that her son was born, all she wanted to do was hold him as she fought for her life. Her ejection fraction, the fraction of outbound blood pumped from the heart with each heartbeat, was as low as 11-12 percent when she gave birth. According to Indaranee Rajapreyar M.D., cardiovascular disease specialist with the Center for Advanced Heart Failure at the Memorial Hermann Heart & Vascular Institute-Texas Medical Center (TMC)/UTHealth, the norm for most healthy people is between 55 and 65 percent. It was at this time Russo learned that if she ever got pregnant again, she would die. Russo recalls how rough those first few days of her youngest son's life were. Due to being jaundiced, he was sent to Texas Children's Hospital while she I magine waking up in the middle of the night gasping for breath. That's what happened to Diane Russo night after night during her last 12 weeks of pregnancy. During her third and final preg- nancy, Russo discovered that if she sat up, the problem went away. But after it kept happening repeatedly, she talked to her OB-GYN, who, told her it was because she was carrying a big baby, just as her previous babies had been. When her condition worsened, she finally had an echocardiogram, which revealed blood in her lungs. Her doctor had her rushed immediately to the Intensive Care Unit (ICU) at CHI St. Luke's Health-Baylor St. Luke's Medical Center. Russo then had a Swan-Ganz pulmonary catheter inserted to monitor the heart's function and blood flow. Due to this pulmonary complication, Russo's baby was induced two weeks stayed in the ICU at Baylor St. Luke's Medical Center. After 21 days, Russo was finally released from the hospital with her ejec- tion fraction measuring at 19 percent. Over the years, it eventually raised. Russo, however, was never the same and had to return to the cardiologist for routine visits every six months for the first five years after the birth of her son, then once a year from then on. Fast-forward 13 years. In late 2011, at a routine cardiologist visit, Russo's doctor gave her some news. "It's time," were the words Russo remembers her doctor telling her, meaning it was time to get on the heart transplant list. By March of 2012, Russo recalls feeling "winded and sluggish." A month later, Russo met with Biswajit Kar, M.D., chief and program director of the Medical Division at the Center for Advanced Heart Failure/ UTHealth, who took an active role in her treatment every step of the way. After waiting a year, Russo was "offered the gift of a heart transplant." She was the 19th heart transplant patient Kar treated. For women like Diane Russo, peri- partum cardiomyopathy (PPCM), is a life-threatening disease of the heart muscle that affects women in the last month of pregnancy and even up to five months after delivery. Although it is quite rare, no one knows for sure how many people have ever had it. Rajapreyar said it could be as low as one in 1,000. While Russo's case was severe and most patients recover after giving birth, symptoms of PPCM are similar to those of heart failure. Besides shortness of breath and excessive fatigue like Russo suffered, other symptoms may include rapid heartbeat or palpitations, chest pain, swelling of the feet or ankles, and tiredness during physical activity. Sriram Nathan, M.D., director of cardiogenic shock at the Center for Advanced Heart Failure/UTHealth, Sriram Nathan, M.D., director of cardio- genic shock at the Center for Advanced Heart Failure/UTHealth, pictured at right, evaluates a patient.